LAUSR

Background Many Michigan communities have experienced threats to the safety of their tap water; the most well-known being the Flint Water Crisis. Little is known about how Michigan families perceive tap water and the extent to which beliefs about tap water safety influence beverage intake. Objective To identify perceptions of tap water safety among low-income mothers residing in Michigan and examine associations between these perceptions, mothers’ beverage intake, infant feeding practices, and young children's beverage intake. Study Design, Settings, Participant In fall 2020, 3,881 low-income women who had given birth at the University of Michigan hospital between fall 2016 and fall 2020 were invited to complete a one-time online survey. Sixteen percent of women responded; 13% (N = 503) were eligible to participate and provided valid data. Measurable Outcome/Analysis Bivariate analyses and multivariable regression were used to examine associations between perceptions of tap water safety and mother-reported self and child beverage intake. Results Eleven percent of mothers reported that their tap water is unsafe to drink and 22% were unsure if their water is safe to drink. Negative perceptions of home tap water and tap water in general were associated with greater consumption of bottled water, using bottled water (vs tap) to make infant formula, and young children's bottled water intake. Mothers with friends or family in Flint during the Flint Water Crisis also drank more bottled water and gave their children bottled water more often than mothers without. Mothers’ negative perceptions of tap water in general were associated with greater sugar-sweetened beverage intake among mothers and young children. On average, mothers spent $27/month on bottled water. Conclusion Distrust of tap water is common among low-income Michigan mothers. This distrust creates an economic and health burden due to reliance on bottled water and may increase socioeconomic inequalities in nutrition. Community-based interventions that improve trust and increase knowledge of tap water safety among low-income women are needed.